Acquired angioedema associated with sinusitis

Acute and chronic sinusitis are major clinical problems faced by physicians in several disciplines. Although there is a much studied relationship between sinusitis and asthma, as well as a well-known association of sinusitis and Wegener's granulomatosis, there is scant evidence suggesting an association of angioedema with sinusitis. Angioedema can be extremely disfiguring, and is potentially lethal due to compromised airways. It is also a frustrating diagnostic dilemma for patients and physicians. A diagnosis is found in fewer than 25% of chronic urticaria patients and much less for angioedema. In this study, we report the cases of nine patients who were treated for chronic sinusitis, but who were referred for episodes of angioedema. Patients with a known diagnosis, such as the hereditary form, or drug or food allergies, were excluded. Based on clinical suspicion or CT scan results, nine patients were treated for chronic sinusitis. Only three had symptoms suggesting a sinus infection at presentation. After sinusitis treatment, all nine patients had a marked improvement in their angioedema. None had further severe angioedema episodes. Some patients continued to have mild episodes of angioedema, which they related to recurrence of sinusitis symptoms, and which responded to antibiotics. The nine angioedema patients in this series all had strong evidence of sinusitis, albeit, most patients had occult disease identified by CT scan. The dramatic improvement in angioedema with sinusitis treatment corroborates a causal relationship. Such findings encourage the investigation of sinusitis in these otherwise idiopathic patients. Sinusitis evaluation may also be indicated for urticaria.